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Informed Consent
Informed Consent is a third season episode of House and the third episode of the season, which first aired on September 19, 2006. The team struggles to diagnose a famous scientist who decides he is ready to die. When the patient refuses to consent to tests, House promises to assist with his suicide after 24 hours. However, when House doesn’t meet the deadline, he has to convince the patient he’s serious about his intentions. Meanwhile, Cameron has to come to terms with the patient’s past. Recap Famous medical researcher Dr. Ezra Powell is busy doing experiments on his rats when he becomes short of breath. He collapses on the floor, and one of the rats takes the opportunity to nibble on his lips. House's ketamine treatment has worn off and he is back to using his cane, but he doesn't want to talk about it, despite everyone's concerns. He tells the team about the patient and his symptoms. They figure that it has to be a heart or lung problem and order a stress test. Powell explains to Cameron that he developed the protocols for the stress test. However, they can’t get his heart rate elevated above 100 BPM, as his lungs are filled with fluid and he cannot sustain the exercise, insisting to stop. Cameron tells House he has fluid in his lung that makes it impossible to do the test, but House just tells Cameron to drain the fluid and run the test again. Cameron come back to tell House they still couldn’t elevate Powell’s heart rate. House orders them to use a hand treadmill instead. However, it still doesn’t work. To shortcut the process, House injects Powell with epinephrine. Powell’s heart rate shoots up, but there are no changes on the EKG. This appears to point to the lungs as the problem. However, when Cameron goes to stabilize Powell, he asks her to just give him the rest of the epinephrine so he can die. Cameron tells House that Powell doesn’t want any more tests, but House figures he’s just depressed and will feel better once he’s treated. However, Chase notes the tests haven’t shown anything treatable and it would be better to give him a fatal dose of morphine. House wants to try antibiotics in case it is an infection, but Cameron can’t figure out how to administer them unless they convince Powell he needs them. However, Powell attempts to remove himself from the life support. They stop him, but Powell doesn’t want to keep living the way he is and he tells House he won’t consent to any further tests. House sends Nurse Previn out of the room so he can talk with him privately. House tries to test Powell’s lungs, but Powell won’t cooperate and Foreman stops him. House threatens to let Powell slowly suffocate in his own lung fluids if they don’t let them help. House strikes a deal with him and asks for one day to do tests on him on the condition that he will help with his suicide if they can’t find anything. The team is opposed, but House tells them he really wants to save Powell. He orders a litany of tests and when they protest they may not be able to finish them in a day, House tells them they can do the ones they don’t finish at the autopsy. The team work through the night, but find nothing. The only thing that seems the least bit unusual is that he is taping his notes. House thinks it might be a sign of memory loss and orders an MRI of his brain. The moral dilemma of whether to assist in his suicide and abide by Powell's wishes, or to ignore what their patient wants drives the team in very different directions. The team members have divergent opinions on the morality of helping Powell die. Cameron despises the idea of interfering with what Dr. Powell wants to do. Both Foreman and Cameron are opposed watching House put Powell to sleep, but Chase seems to have little problem. Wilson says that House has done it before "plenty of times" and House insists that it was only "to patients that he knew were terminal." In an example of Chase's ongoing character development, among the four, Chase is the most religious. House comes in with a diagnosis, but Powell is too knowledgeable and realizes House is lying. Powell won‘t agree to an extension, but House reminds him that there is no proof he is terminal. Instead, Powell asks to be released so he can die slowly. Finally, House goes to Powell, to apparently to give him the morphine dose. He sends his team out of the room, but Chase stays behind to help. However, instead of killing him, House puts Powell in a coma, so that he can do his tests in peace. He sends Chase to get a ventilator. Cameron refuses to partake in any more of House's plans, but House tells her she can’t both repect his wishes and keep him alive. However, her last scan shows scarring in his lungs. House orders immunoglobulin and tests for Lupus. Chase and Foreman run the tests, but see Nurse Previn wondering what is going on. It’s soon clear she has told Cuddy, but Cuddy is supportive of House’s decision to treat against the patient’s will instead of killing Powell. Foreman reports that Powell got worse on immunoglobulin. To confirm pulmonary fibrosis they need to do surgery for an open-lung biopsy. House finds Cameron and directs her to an article in an old medical journal to better understand Powell and his beliefs. Wilson comes to see House to ask about his leg and about the patient. Wilson thinks House is only keeping Powell alive to satisfy his own curiosity. Cameron comes to House to tell him that she read Powell experimented on infants without parental consent. House tells Cameron that was common practice among Powell‘s peers at the time and it‘s what Cameron thinks about what Powell did is important, and that they can‘t both help Powell live and help him die. During the surgery, Powell's lung collapses and House is forced to intervene and notices that Powell has lost reflex capabilities in his right side, but not his left. However, in order to proceed with additional diagnostic procedures, House has to wake Powell from his coma. Powell regains consciousness and is astounded and upset to find he is still alive. Powell still refuses tests and demands to be discharged. He starts pulling out tubes. However, House finds that Powell has also lost sensation in his abdomen and left leg. This indicates a disease of the peripheral nerves. House demands Cameron obtain a skin biopsy for the other diseases he may have, and agrees she doesn’ have to lie to get it. Cameron and Powell engage in conversation where Powell reveals that he feels things such as informed consent interfere with research and thus he did not let it stand in his way. Cameron slices a piece of skin off using his perspective as her solution to the moral dilemma, upon which Powell commends her for doing what she believes is right. They start tests which are all negative, until House ends up asking them to test for amyloidosis. House figures their original assumption that there was nothing wrong with Powell‘s heart was wrong because they didn‘t follow proper protocols for the test. The test is positive, but Chase also finds that it is of sub-type AA and therefore is an untreatable and terminal form of the disease. House tells Powell about the diagnosis and Powell congratulates him for finally finding his answer. The following morning, Cuddy comes into House's office to let him know that Powell passed away at 2:30 am, although he was declared stable at 2:00 am. House denies any knowledge of what happened and asks Cuddy if she would want to know even if he did. House then goes to Cameron, who is seen dressed in black, crying at the hospital chapel, suggesting that Cameron aided in the passing away of Powell by euthanizing him. House tells Cameron that he is proud of her, and leaves. Medical Errors * During placement of the thoracostomy tube, air seems to evacuate with no application of suction. Negative pressure is needed to re-inflate lungs and suction is required. Also, no aseptic technique is used. * At one point, House claims that it could Kawasaki disease due to the symptoms. But in the season two episode All In, he claims Kawasaki disease doesn't affect the elderly. * In the scene where House is about to administer morphine to Dr. Powell, the front shot shows a syringe with 4 CCs, while shot showing Foreman's face shows a syringe with only a two CCs Major Events * Cameron, Foreman and Chase discover that House is using his cane again. * House and his team find themselves being asked to help Ezra Powell, the renowed medical researcher end his life. * Ali begins calling the clinic in an attempt to get to House. * Cameron refuses to help House. Foreman and Chase treat Powell. * After successfully diagnosing Powell, House learns the next morning that he passed away during the night at 2:30 A.M. * It is revealed that Cameron was the one who helped Powell die. Clinic Patient House is examining a patient's throat. To keep him from talking, he pretends to be the patient talking to his daughter who is also in the room. She thinks House is funny. Once the patient denies having anal sex with intravenous drug users, House diagnoses the father with a common cold. When House drops some papers, the daughter helps him pick them up. Later, the daughter, Ali, tries to get in touch with House by leaving messages for him at the clinic. Ali comes back to the clinic to see House to get more medicine for her father and to ask why he hasn't returned her calls. He intimates she is too young to call back right away, but she says she was only calling to thank him. However, as she leaves, she tells House she will be 18 in six months and he can call her back then. The next morning, he finds a calendar on his desk with Ali's birthday marked in bright red. Zebra Factor 6/10 Amyloidosis is fairly rare, and in addition it can present with any number of symptoms, none of which are unique to the disease or provide a definitive diagnosis. Trivia and Cultural References *When Cameron tells House that Powell wants to die, House says that he wants to play a little game called "block my spike with Misty May." This is a reference to the former Olympic beach volleyball player who won three Olympic gold medals and, together with her partner Kerri Walsh Jennings , is considered the greatest beach volleyball team of all time. *Tuskegee is another reference to the Tuskegee syphilis experiment, which was also mentioned in Pilot. Willowbrook is most likely a reference to the Willowbrook State School, a notorious institution for children suffering from mental retardation that was closed in 1987 after a public outcry that led to legislation protecting the institutionalized. *Johnny David is most likely a reference to Johnny David Damon, a baseball player who has played for (among other teams) the Boston Red Sox and the New York Yankees. *House's line "just get me a pound of flesh" is a reference to Shakespeare's 'The Merchant of Venice'. *Laura Innes who directs this episode is best known for playing Doctor Kerry Weaver on the medical series, "ER". *House's line "Pay no attention to the man behind the curtain" is a reference to The Wizard of Oz. This reference is particularly appropriate as Joel Grey, who plays Powell in this episode, also played the Wizard of Oz in the Broadway show Wicked. *Song playing during last minutes of the episode is Into Dust - Mazzy Star Cast * Hugh Laurie as Gregory House * Lisa Edelstein as Lisa Cuddy * Omar Epps as Eric Foreman * Robert Sean Leonard as James Wilson * Jennifer Morrison as Allison Cameron * Jesse Spencer as Robert Chase * Joel Grey as Ezra Powell * Leighton Meester as Ali * Stephanie Venditto as Brenda Previn * William Charlton as Mark * Bobbin Bergstrom as Nurse * Alexander Hall as Doctor http://es.dr-house.wikia.com/wiki/Consentimento_Informado Category:Episodes Category:Season 3 Category:Spanish Category:Zebra Factor 6 Category:Episodes ending in the patient's death